Dupixent — CareFirst (Caremark)

Initial criteria

• Member age ≥ 18 years
• If member has previously received a biologic drug (e.g., Nemluvio) indicated for prurigo nodularis in the past year, authorization of 6 months may be granted
• Member has pruritus lasting at least 6 weeks
• Member has a history or signs of repeated itch-scratch cycle (e.g., scratching, picking, or rubbing)
• Member has a minimum of 20 nodular lesions
• Member has had an inadequate response to one of the following: a medium to super-high potency topical corticosteroid (see Appendix A), a topical calcineurin inhibitor, phototherapy (e.g., UVB, PUVA), or pharmacologic treatment with methotrexate or cyclosporine OR intolerance/clinical reason to avoid topical corticosteroid plus calcineurin inhibitor OR methotrexate plus cyclosporine

Reauthorization criteria

• Member age ≥ 18 years
• Member has achieved or maintained a positive clinical response as evidenced by either low disease activity (clear or almost clear skin) OR reduction in pruritus intensity and improvement in extent and severity of nodular lesions

Approval duration

Initial 6 months, Reauthorization 12 months